The 4-year outcomes of a trial of water vapour therapy using the Rezūm system for lower urinary tract symptoms (LUTS) caused by BPH have been reported. In this randomized, controlled trial, mean International Prostate Symptom Score improvement at the 4-year follow-up point was consistent with the 3-month outcomes at 46.7%. Surgical retreatment rate was 4.4% and no changes in sexual function occurred. Improvements in incontinence scores were maintained over the 4 years. The results of this trial show that the Rezūm system is effective for symptomatic relief of LUTS in men with BPH.